Clonazepam and Propranolol for Panic Attacks

Clonazepam for Panic Disorder

The American Geriatrics Society lists clonazepam as potentially inappropriate in older adults due to its potential to cause somnolence, ataxia, depression, dizziness, fatigue, and cognitive impairment 2
Clonazepam can worsen or cause sleep apnea at doses of 0.5-1.0 mg, and patients should be screened for sleep apnea before treatment 1
Patients typically cannot reduce doses of clonazepam despite tapering attempts, with same-night relapse upon discontinuation, highlighting the need for careful management and monitoring 1

The American College of Physicians recommends screening for sleep apnea, gait disorders, liver disease, and history of substance abuse before initiating clonazepam treatment 1
Baseline neurological examination with attention to cognition should be performed before starting clonazepam, and patients should be monitored for cognitive decline, motor coordination problems, and morning sedation 1

The National Institute of Mental Health suggests considering psychological treatment based on CBT principles for people concerned about prior panic attacks, which can be used in combination with clonazepam for optimal long-term outcomes 4

The American Psychiatric Association notes that propranolol may induce depression and should be used cautiously—if at all—in panic patients with concurrent depressive illness, and there is no evidence supporting propranolol 20 mg as monotherapy or in combination with clonazepam for panic disorder 3